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Tracheo-innominate artery fistula is rare, but when it happens, it’s catastrophic. The innominate artery runs directly in front of the trachea, and prolonged cuff pressure can erode into it, creating a direct arterial bleed into the airway. The first sign may be a small, self-limited sentinel bleed. Hours later, it can progress to massive, pulsatile hemorrhage. If you suspect it: Hyperinflate the cuff immediately to tamponade the bleed. If bleeding continues, apply direct digital compression thr
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